Pediatric Fungal Endocarditis Clinical Presentation

Updated: Dec 21, 2020
  • Author: Sandy N Shah, DO, MBA, FACC, FACP, FACOI; Chief Editor: Syamasundar Rao Patnana, MD  more...
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Patients with fungal endocarditis (FE) may have a history of cardiac surgery complicated by symptoms of infection, such as fever, deteriorating cardiac status, embolic phenomena, and wound dehiscence.

A history of intrathoracic or systemic fungal infection with spread to the heart is rare.


Physical Examination

On rare occasions, fungal endocarditis presents as typical bacterial endocarditis, with fever, weight loss, splenomegaly, splinter hemorrhages, Roth spots (pale retinal lesions with surrounding hemorrhage), Osler nodes (painful nodular lesions on the finger and/or toe pads), petechiae, Janeway lesions (painless hemorrhagic plaques on the palms and/or soles), arthritis, and a new or changing heart murmur.

Often, an indwelling central venous catheter (CVC) is present. The use of CVC for central hyperalimentation (CHA) is an additional risk factor.

Occasionally, positive blood culture results or positive culture results of other tissues and fluids (despite negative blood culture results) are the only evidence.

Cardiac involvement, without other symptoms or signs of infection, may be the only clinically apparent feature.

An inflow obstruction (superior vena cava syndrome), cough, hoarseness, dysphagia, and/or a full sensation in the ears due to an infected thrombus may be the sole manifestation of disease.

In neonates, symptoms are often nonspecific and include apnea and bradycardia, hypothermia, poor perfusion, feeding intolerance, need for increased ventilatory support, and evidence of septic emboli. Rarely, a new or changing heart murmur is present.

In neonates, Janeway lesions, petechiae, splinter hemorrhages, and evidence of multiple septic emboli have been reported, although Osler nodes and Roth spots have not been reported.

In the postoperative period, patients may have symptoms such as fever, cardiac decompensation, a new or changing heart murmur, evidence of embolic phenomena, and wound dehiscence.

Superior vena cava syndrome may manifest as hoarseness, swelling of the face, wheezing or stridor, and/or venous engorgement.